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hme news / september 2017 / www.hmenews.com 11
Guest commentary
By Jonathan t emple
O
n Feb. 10, 2017, the song, "Happy days
are here again" and "For he's a jolly good
fellow" could be heard from California to
n ew York, from the Redwood Forest to the Gulf
Stream waters. High fives all around, Party City!
Why? Dr. Tom Price, the undisputed supporter of
the DM e industry, was nominated and confirmed
to the Trump Cabinet as Health and Human Ser-
vices Secretary.
If I heard it once, I heard it many times over: We
could not have hand-picked a better person to be
in this position. It was as if my brother-in-law or
an old college buddy was now able to make a real
difference, especially for the DM e industry. Today,
I'm having serious doubts about our champion.
The question that's on everyone's mind is: What is
taking so long for Dr. Price to act on the very thing
he leads the way on? It reminds me of the movie
" b raveheart" when the evil king's army (CMS, they
are not totally evil, but almost...) is charging on
horseback with spears drawn, racing to destroy the
good guys (the DM e industry) who are on foot and
look like they are on their last legs. In the movie,
the good guys at the last-minute stave off the attack of CMS
(oops, I meant the evil king). One can only imagine how
the good army felt as they are holding
their ground as the thundering hooves
of the evil army approaches.
According to information obtained
through the Freedom of Information
Act retrieved by industry advocates
from data.medicare.gov, the estimated
number of DM e suppliers and locations
has dropped by nearly 38% nation-
wide. I believe that number to be much
higher due to the number of suppliers
who chose to sell out to larger compa-
nies. It is hard to believe that nearly half
of the good guys are gone. If Dr. Price
fails to act soon, more of the good guys
are soon to follow.
What is confusing is that Dr. Tom
Price has been a strong champion of the
DM e industry over six terms in Con-
gress; he knows and has known that the
evil army is approaching and the good
guys are in harm's way. Dr. Price has
spent considerable valuable time and
effort trying to make changes to save
the good guys. Simply put, the DM e
industry needs relief and they need it tout suite.
Many providers are scratching their heads (me, I've got
a bald spot), wondering why it's taking so long for some-
one who knows what DM e companies are going through.
Sure, the battle over the Affordable Care Act (ACA) is rag-
ing on in Congress and in the rest of the country. Dr. Price
is smack dab in the middle of it, but surely our hero could
take a moment from the current stalemate of the ACA and
save the good guys.
The good guys need to do what we did in Washington,
D.C., in May. The good guys convinced over one-third of
Congress to sign on to a letter urging Dr. Price to act on our
issues and act now. One would think that the 21st Century
Cures Act was a clear enough seal of approval for Dr. Price
to act on. The act was signed by President b arack Obama.
e ven President Obama recognized that the cuts Medicare
made in 2016 were too deep.
The good guys need to start squeaking like a giant Ferris
wheel. The DM e industry has the Cures Act on its side, two
Dear Colleague letters, 38% fewer providers and recently
The n ational Federation of Independent b usiness ( n FI b )
has recognized how Medicare has negatively affected small
businesses.
What more does Dr. Price need? A flaming bush in the
wilderness? Good guys, let us rise up and start making some
serious noise before it's too late!
hme
Jonathan Temple is the chief servant at OxyMed, LLC in Birmingham,
Ala.
Hey Dr. Price! The good guys need you tout suite!
Forget your congressman, develop relationships with aides
I
A l WAYS enj OY reading about our industry's attempts at influencing the minds
of our elected officials. Frequently, I think that after the past 20 years of nega-
tive reimbursement the industry's owners and leaders might try to change
tactics. I don't like political discussions in today's climate, but the reality is that
home medical equipment relies on government spending.
I don't think any of the last three Republican-controlled Congresses (with or
without Dr. Tom Price) would be looking to add cost to the Medicare program,
which is what bid relief would accomplish. How many of your readers bet on
Republicans the past few election cycles? Did manufacturers that despise the
Obamacare tax on medical devices forget that they rely more on financially
viable providers?
You might also believe Republicans support small business, limited business
regulations, and everyone's favorite low taxes. For me, raise my taxes to pay for
the Medicare program because lowering your taxes doesn't help one bit when
you are losing money. You only pay the government when you have enjoyed
an income. Did some of you forget that most basic principle? If so you might
want to think again at the voting booth in the future.
After reading a recent article about getting signatures for a letter (demanding
bid relief), I had to chuckle and offer some basic advice. Most of those letter
requests are going to wind up in the circular file. The best thing you can do for
yourselves (your businesses) is do what every other business leader does when
attempting to get your legislator's attention and make a campaign donation. I
know you have a lot of reasons why not to, but it works. My legislator contacted
me personally and he was speaking at the Pacific Association of Medical e quip-
ment Suppliers shortly after. The relationship became so good I actually had my
congressman submit claims on my business' behalf for claims that were denied
for bogus reasons that all providers regularly experience. My congressman sent
the claims directly to the claims supervisor on paper and a letter of apology and
explanation accompanied a check in short order. Have any of you ever requested
this of your legislator? How are those appeals working out for you?
Congressional fly-ins sound fun, but they are expensive and they will never
be more effective than meeting your legislator in your district at their office.
Don't wait for somebody else to save your business; everyone is too busy sav-
ing themselves. The industry lobbyists mean well but the results just aren't
there. So just walk up anytime during a normal workweek and meet with one
of the representative's aides or call and make an appointment. A meeting with
an aide might be more productive than bombarding Congress with a flood of
suits clamoring for attention at the same time. I know you might miss a happy
hour or two, but elected officials can hide in Washington, D.C. Their offices in
your district can't. Develop relationships with the staff at your office and you
may be surprised at their willingness to learn more about your business and
help you when you need it. Which is now.
—Larry Caplan has been an HME industry and patient advocate since 1978. His tenure
includes stops at many national providers. He was most recently the president and CEO of
his own business, Respicare, in Seattle/Tacoma Wash.
r equirement puts A tp s in A bind
W
O ul D R e S n A have any interest in pursuing and requesting CMS/Medi-
care to lift the rule requiring an ATP to be a W2 employee and not a 1099
contractor?
I believe this rule surfaced as a requirement around 2009, which states that a
DM e rehab company must employ W2 ATP on staff. At the time, R e S n A was
involved and had some input. There was also some input and involvement with
the IRS over this decision.
I understand the importance of being a certified ATP, but CMS thought it would
be a conflict of interest to let companies contract with ATPs, and I beg to differ.
Here's why this is unfair and not right. If I'm the owner of my company and also
the ATP on staff as a Medicare provider, then I can pay myself and file/pay my taxes
as a corporation/W2 employee or sole-proprietor/1099. All insurance payments to
a DM e company are reported as 1099.
Why is all of this a concern? I, like a lot of ATPs, have lost jobs and cannot sus-
tain a business with the complexity of being a Medicare provider. Smaller compa-
nies may not be able to afford a full-time W2 employee ATP. It puts companies in
a difficult position.
If you cannot relocate and/or find a job as an ATP in your area, then you can
no longer practice/apply your profession for remuneration. A lot of ATPs need the
work and would be willing to accept 1099 contracted work as an independent ATP.
The primary payer for rehab power chairs is usually Medicare and the second big-
gest payer is state Medicaid programs, which typically follow Medicare guidelines,
although, this rule may not apply for Medicaid and private payers.
—Steve VanHoose, ATP
Fre A k people out A nd s A y hi
T
H e S OCI e TY for Human Resource Management (SHRM) had its annual confer-
ence in n ew Orleans recently. I wish I could have attended. I followed much
of the activity via Twitter and read many of the tweets from attendees at dif-
ferent sessions. e ach would include a quote nugget they found of interest to share.
One I read was something stated by a speaker. " b e a disruptor in HR by freaking
people out and saying hi to everyone you see".
When I read that, I got kind of sad, but realized that the simple things I was
taught as a kid are now considered a "disruptor." Then I reflected on an experi-
ence I just had at a client's office. I arrived early so I could observe people getting
to work. I watched as one of the VPs entered the office and did not acknowledge a
single person on the way to her office. I held a management training session later
in the day and called her out. Hey, conflict is healthy if it helps us grow. I told her
what I observed and challenged her that the team she manages will never be fully
engaged, pursue excellence, and try and be the best they can be if they do not feel
like she cares about them personally. A simple smile and "good morning" would
have gone a long way.
So, I guess the speaker was not entirely out of place calling "hi" a disruptor.
Thanks Mom and Dad for preparing me to be "cutting edge".
—Richard Davis, SPHR, SHRM-SCP, is with HirePowerHR.
Letters
to
the
editor
The good guys need
to start squeaking
like a giant Ferris
wheel. The DME
industry has the
Cures Act on its side,
two Dear Colleague
letters, 38% fewer
providers and
recently The National
Federation of
Independent Business
(NFIB) has recognized
how Medicare has
negatively affected
small businesses.
What more does Dr.
Price need?